A surgical perspective on the current staging in neuroblastoma--the International Neuroblastoma Staging System proposal.

In the three most widely used neuroblastoma staging systems--Evans, Pediatric Oncology Group (POG), and TNM-Union Internationale Contre le Cancer (UICC)--few staging problems are presented by the completely resected tumor or with the patient who has metastatic disease. Difficulties arise with the localized tumor when there is extension across the midline and with the demonstration of lymph node involvement. A new International Staging System for Neuroblastoma (INSS) is proposed that incorporates both lymph node invasion and extension across the midline into surgical staging. Clear criteria for diagnosis are established and clinical responses are defined. New prognostic factors may be added. The surgical role remains significant in staging, diagnosis, and therapy. Use of a common system throughout the world would facilitate the evaluation of clinical trials and help achieve the goal of developing optimum therapy for the biologically different types of neuroblastoma.